Transcript Document 18144

HL7 Quality Reporting
Document Architecture DSTU
CDA Release 2, US Realm
Pele Yu, MD MS FAAP
HL7 September 2008 WGM (Vancouver, BC, Canada)
Quality Reporting
Document Architecture
To develop an electronic
data standard for exchange
of patient-level quality
measurement data
between healthcare
information systems.
Status Quo
Future
of Quality
in Quality
Measure
Measure
Reporting
Reporting
Feedback to clinicians
Paper Medical
Records
Data Entry
100% manual process:
data abstraction
and data mining
Prepare
data
for analysis
Requestors of
Quality Data
Quality
Improvement
Organizations
Key-boarding or
manual entry
Accrediting
Organizations,
Medical
Societies, The
Alliance
Point of Care
clinicians
Payers
Electronic Health
Records
Proprietary
data
QRDA
formats
Complete?
www.kidsquality.org
Coordination with Related Efforts
NQF, NCQA, AMA, APQ....
Measure definition
Measure Development
The Collaborative
eMeasure specification
eMeasure Specification
QRDA
Aggregators, Requestors
www.kidsquality.org
Data
Elements
for Quality
QRDA
AHIC, HITSP Use Cases
QRDA
feedback
HIMSS IHE:
Multi-party
choreography
using HL7
messages,
services
HITEP
QRDA Project History
• Phase 1: September 07 – January 08
– Proof of concept, use CDA for quality reporting
• HAI reports for CDC (SDTC)
• SDTC interest in CDA based non-clinical reporting
documents – Structured Documents Architecture (SDA)
– Domain Analysis
– Requirements Analysis
• Phase 2: May 2008 to present
– DSTU Ballot
– QRDA Implementation Guideline for 2 Pediatric
Measures (CHCA)
– QRDA Reporting Categories (MedAllies)
• NHIN Trial Implementation demonstration project in NY
• Summary patient record exchange using CDA
QRDA Draft Standard 2008
• Category 1 – Patient-Level Reports
– For DSTU Ballot
• Category 2 – Summary Reports
– Informational, for Comments
• Category 3 – Calculated Reports
– Informational, for Comments
QRDA Category 1 Specifications
• Header
– Header
• US Realm
• Unique CDA template ID, LOINC code, and Title
– Participants
•
•
•
•
•
Target  a single patient
Author  one or more entities (person, organization, device)
Informant  one reporting entity (person, organization)
Custodian  one custodian (person, organization)
Legal Authenticator  one legal authenticator (person, organization)
• Body
– One body
– One or more sections, subsections (Measure Set, Measure)
• Section
–
–
–
–
Measure Set Section (measure set name, version, OID, description)
Measure Section (measure name, version, OID, description)
Reporting Parameters Section (applicable reporting period)
Patient Data Section (Re-use of CCD and CDA, if applicable)
QRDA Specifications – RIM Constructs
• Header
– Header
• US Realm
• Unique CDA template ID, LOINC code, and Title
– Participants
•
•
•
•
•
Target  a single patient
Author  one or more entities (person, organization, device)
Informant  one reporting entity (person, organization)
Custodian  one custodian (person, organization)
Legal Authenticator  one legal authenticator (person, organization)
• Body
– One body
– One or more sections, subsections (Measure Set, Measure)
• Section
–
–
–
–
Measure Set Section (measure set name, version, OID, description)
Measure Section (measure name, version, OID, description)
Reporting Parameters Section (applicable reporting period)
Patient Data Section (Re-use of CCD and CDA, if applicable)
QRDA Deliverable
• Implementation Guides for QRDA Category 1
Pediatric Measures
– VON Neonatal Admission Hypothermia Measure
• Outcome measure
– CHCA Body Mass Index (BMI)
• Process measure
• Rationale
–
–
–
–
Few data points, well-defined
Pilot potential
Pediatric measures on NQF Roadmap
Relevant to project stakeholder (CHCA)
Implication of DSTU
• QRDA is feasible
–
–
–
–
RIM adaptable
CDA adaptable
Strong HL7 support
Industry awareness achieved
• Ready for industry use
– HITSP
– IHE
– Pilot efforts
• Barriers for adoption and progress
– Lack of continuity in effort
– Lack of formal project management structure
Next Steps
• QRDA DSTU Ballot reconciliation next few months
– Resolve issues without substantive change and publish DSTU, or
– Resolve issues w/ substantive changes, then re-ballot
– Implications
• QRDA Phase 3
– Funding for future development to refine DSTU leading to
Normative Standard
• Category 1  DSTU
• Category 2 and 3  include in next ballot cycle/s, if enough work is
done (MedAllies, etc)
– Create solid links with industry
• Harmonize efforts (IHE, Collaborative, JCAHO, HEDIS, etc)
• Engage vendors and MDOs
– Pilot and demonstration projects
• Vendors, hospitals, QIOs